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onitoring System Certification <br />Site Address: 1210 E. HAMMER LANE Date of Testing/Service: <br />@ WEST LANE <br />D. Results of Testing/Servicing <br />Software Version Installed: $,05 <br />Complete the following checklist: <br />07/10/2001 <br />❑ Yes <br />❑ No * <br />Is the audible alarm operational? <br />® Yes <br />❑ No' <br />Is the visual alarm operational? <br />® Yes <br />❑ No * <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />® Yes <br />[__j No' <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br />interfere with their proper operation? <br />❑ Yes <br />❑ No * <br />Ej N/AIf <br />alarms are relayed to a remote monitoring station, is all communications equipment(e.g. modem) operational? <br />® Yes <br />❑ No * <br />❑ N/A <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive <br />shut -down (check all that apply) Sump/Trench Sensors; ❑ Dispenser Containment Sensors. <br />Did you confirm positive shut -down due teaks and sensor failure/disconnection? F9 Yes 0 No <br />❑ Yes <br />❑ No * <br />❑ N/A <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e. no mechanical <br />overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill points(s) and operating <br />properly? If so, at what percent of tank capacity does the alarm trigger? % <br />® Yes <br />® No * <br />Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the <br />manufacturer name and model for all replacement parts in Section E, below. <br />® Yes <br />No <br />as liquid found inside any secondary containment systems designed as dry systems?(check all that apps Product; <br />® Waterif yes, describe causes in Section E, below. <br />® Yes <br />❑ No. <br />Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable <br />® Yes <br />❑ No * <br />Is all monitoring equipment operational per manufacturer's specifications? <br />* In Section E below, describe how and when these decifiences were or will be corrected. <br />E. Comments: <br />page 2 of 3 <br />